17D2038590 CLIA NUMBER - WALGREENS #6005

Laboratory Demographics

  • CLIA Code: 17D2038590
  • Facility Name: WALGREENS #6005
  • Facility Address: 2229 NORTH MAIZE ROAD
    WICHITA, KS
    ZIP 67205
  • Facility Phone: 316 722-0741
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: COURTNEY R. BLACK
  • NPI Number: 1225043441
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 17D2038590
LAB Type Pharmacy
Facility Name WALGREENS #6005
Street 2229 NORTH MAIZE ROAD
City WICHITA
State KS
ZIP 67205
Phone 316 722-0741
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/12/2025
Certificate Expiration Date 5/11/2027
Facility Type Pharmacy
Lab Director COURTNEY R. BLACK

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This page was last updated on: 9/29/2025